Adjuvant chemotherapy for locally advanced bladder cancer—a step closer to ending the ongoing controversy

The use of perioperative chemotherapy for patients undergoing radical cystectomy for invasive bladder cancer has been increasingly employed over the last several decades in an effort to improve survival. While neoadjuvant platinum based chemotherapy has level 1 evidence showing a survival benefit from randomized controlled trials and a meta-analysis, the existing evidence supporting the use of platinum-based chemotherapy in the adjuvant setting remains poorly defined and controversial (1,2). Attempts to answer the question regarding the benefit of adjuvant chemotherapy in patients with locally advanced disease after radical cystectomy (pT3/pT4 +/− node positive disease) through clinical trials have been fraught with poor accrual. Consequently, the existing evidence for adjuvant therapy relies on the data from various meta-analyses that demonstrates benefit for adjuvant chemotherapy (3-6).